Opinion: No president should assume office without a ‘fitness for duty’ exam

Posted Dec 5, 2018

President-elect Donald Trump, center, listens to a member of the military in the stands as he watches an Army-Navy NCAA college football game at M&T Bank Stadium, Saturday, Dec. 10, 2016, in Baltimore. (AP Photo/Andrew Harnik)

(THE CONVERSATION) Since the beginning of Donald Trump's presidency, mental health professionals have come forth in historically unprecedented ways to warn against entrusting the U.S. presidency to someone who exhibits what we have called his "dangerous" signs.

The observed signs have included "grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality."

One can deduce, for example, that the minimal requirement for a U.S. president is to have the ability to take in proper information and advice, to process that information and to think about consequences before making sound, reality-based decisions.

Fitness for duty tests also assess an employee's capacity to work without putting their own or others' health and safety at risk.

Since President Trump took office, news reports have revealed that discussions had been held among GOP members and even high-level government officials about the 25th Amendment. That amendment allows the removal of a president who is unable to discharge the powers and duties of his office.

As a forensic psychiatrist, it is of utmost importance that I make the boundaries of my expertise clear. I should not comment outside my area, but within my expertise, I can speak authoritatively.

The removal of a president because of inability is ultimately a political decision, but politicians and the public would to well to proceed in an informed manner.

Disability, incompetence and unfitness are legal and not mental health concepts. Yet no court of law would consider making these determinations without input from medical experts.

To invoke the 25th Amendment without relevant evidence could also expose the process to endless use and misuse for partisan purposes. Medical expertise can serve as a neutralizing ground. It is based on verifiable clinical observations and uniform standards of practice. A panel of experts could bring forth consensus where there are sufficient, high-quality data.

In the current situation, if the patterns of impulsivity, attraction to violence and detachment from reality we are observing in the president are psychological pathology and not political strategy, it is incumbent on mental health professionals to inform the appropriate authorities, regardless of the context in which they are occurring. Non-experts can then be alerted to the need for more detailed examination.

The 25th Amendment

The proper role of the medical professional regarding the 25th Amendment is to wait for a consultation to be requested and not to interfere in the political process.

However, taking steps to protect the public's health when there are dangers is very much the health professional's domain and may entail alerting the public about the need for an urgent evaluation.

In a healthy democracy, it is reasonable for the people to require that their leader meet the minimal mental and physical capacity to serve in the office, and for them to be informed if he or she fails to do so.